MEDICARE: ONE LIFE CHIROPRACTIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	5247-12	WI

General Provider Information

NPI Number	:	1770015257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONE LIFE CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	716 SAINT CROIX ST
Second Line	:
City	:	PRESCOTT
State	:	WI
Zip	:	54021-1445
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	716 SAINT CROIX ST
Second Line	:
City	:	PRESCOTT
State	:	WI
Zip	:	54021-1445
Country	:	US
Telephone Number	:	715-262-1147
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CARL CALABRESE
Credential	:	DC
Telephone Number	:	715-262-1147

Provider Enumeration Date	:	04/03/2017
Last Update Date	:	04/03/2017

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Directions to “ONE LIFE CHIROPRACTIC LLC ” Practice Location

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